Prevention of mother-to-child transmission of HCV is dificult as there are no proven interventions to reduce this risk. Neither mode of delivery nor
breastfeeding are reliably linked with transmission. The development of effective drugs against HCV that can be given safely during pregnancy might be a future
option.
2.5 Screening for HCV infection
Screening for HCV infection is done using HCV serological testing. If positive, a NAT for HCV RNA assay is needed to conirm chronic HCV infection. Several
screening assays have been evaluated by WHO, and sensitivity, speciicity, and positive and negative predictive value results are available.
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It is important to consider the possibility of infection with other bloodborne viruses in persons with
HCV, and to offer screening for HBV and HIV in addition to HCV. Screening for other infections, for example TB, is also indicated in some groups at risk, such
as people living with HIV, prisoners and PWID.
2.6 Care of patients with HCV infection
The spectrum of disease in persons infected with HCV extends from mild ibrosis to cirrhosis and HCC. Compensated cirrhosis may progress over time
to decompensated cirrhosis associated with ascites, oesophageal and gastric varices, and eventually to liver failure, renal failure and sepsis, all of which are
life-threatening. HCC may also occur at a rate of 2–4 per year in persons with cirrhosis. The diagnosis of decompensated liver disease is based on both
clinical examination and laboratory monitoring, and therefore a careful medical examination of patients must be made prior to commencing therapy. The stage
of disease may be assessed by liver biopsy or by using a variety of non-invasive methods. These are discussed further in Chapter 6.2.
Staging of HCV infection is important as it results in the identiication of patients with advanced disease, a group that requires enhanced monitoring
and prioritization for treatment before the onset of decompensated cirrhosis. In many high-income countries, all persons with chronic HCV infection who do not
have a contraindication for therapy are considered to be suitable for treatment although many persons with mild-to-moderate disease may elect to wait for
newer, less toxic and more eficacious medicines. In low- and middle-income countries, where access to treatment is limited, the stage of ibrosis may be used
to prioritize treatment for patients with more advanced disease e.g. patients with cirrhosis or those with
≥F2 ibrosis. Patients infected with HCV often have other co-morbidities such as HBV, HIV, TB
and substance use. Related WHO guidance is available for persons who inject
drugs and for those infected with HIV see section 2.4. Excessive alcohol use is common in some populations infected with HCV and can accelerate disease.
WHO guidance on alcohol reduction is discussed in detail in Chapter 6.1.
2.7 Treatment of patients with HCV infection
